A WFP report says 5 percent of Pakistanis cannot afford even energy-only diet
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The World Food Programme has released an analysis report of nutrition (cost and affordability) in Pakistan titled Fill the Nutrient Gap. This is an important step towards achieving the Sustainable Development Goal-2: (zero hunger by 2030). The report analyses data collected through the Benazir Income Support Programme disbursements.
Two major aspects of the study are: energy requirements (2,000-2, 500 Kcal per day) and nutritious or balanced/ healthy diets. Most of the energy in the common man’s diet in Pakistan comes from wheat, rice and edible oils. A nutritious diet includes animal/ plant protein, egg, dairy products and an assortment of vegetables, fruits and nuts to meet vitamins, minerals and roughage needed for a healthy body. It should be accompanied with safe drinking water, which is another major challenge in Pakistan.
The data analysis is segregated into rural and urban households receiving BISP support across the four provinces. Household income and expenditure data of 2013-14 was used along with corresponding BISP payments. The inferences drawn are relative to the timelines and not necessarily according to the current income/ expenditure and market prices. 40 kg wheat was at that time priced at Rs 1,300. The price had gone up to Rs 5,000 in the year 2023. There is a huge difference in the cost per meal for basic energy vs nutritious food. The differences between urban and rural consumers are significant in three of the four provinces. The variation between urban and rural households in the Punjab is relatively small.
Overall, the report highlights the inability of 5 percent of the population to afford even energy-only diet and inability of 66 percent to afford nutritious diet. The significantly low cost of energy-only diet in rural Balochistan compared with other provinces needs to be backed by further justification and evidence. The report considers each province as a distinct unit for food system, diets and culture and ignores intra-provincial variations. Based on the current food prices and food security reports, a nutritious diet per capita could cost Rs 270–400 per capita per day.
Thanks to the food habits, the daily diets in Pakistan are built around low-cost starch/ staples with limited diversity. There is an element of addiction to wheat, so that most people do not feel satisfied without a chapatti even if 2,500 calories have already been consumed. There is evidence to suggest that gluten, a wheat protein, has metabolic control and that there are people who cannot tolerate it in diet because of a disease/ condition called celiac. However, many such people continue to consume wheat.
The BISP social protection is effective as long as it is available to the poorest of the poor. However, the cause of healthy nutrition in Pakistan is not limited to the affordability aspect only. Overall malnutrition prevalence is far higher than the number of people below the poverty line.
The low cost of energy-only diets sounds good. However, restricted access is a greater economic challenge faced by a large proportion of rural populace.
This is telling of a brewing crisis. If rural populations cannot access even low-cost diets, they also have lower productivity as members of society/ economy. Losing out on productive rural workers presents a grave danger to the future of agricultural production.
Affordability and diversity challenges require investment in technology adoption to increase per unit productivity. Biotechnological and climate-smart strategies in agriculture/ food systems can mitigate food scarcity. Selective school meals or biscuits/ cookies will not serve the purpose.
The economic cost of malnutrition focuses on demand side of enhancing affordability through cash transfer and enhanced purchasing power. However, it ignores the systems approach to introduce nutrition-sensitive interventions in the farming practices. There is a need to transform the system from ‘productivity’ alone to a ‘nutrition-sensitive’ system. Transition to nutrition-sensitive systems needs many steps including diversification of agriculture beyond five crops; developing nutrition-sensitive crops and crop varieties; incentives to promote nutrition-sensitive crop varieties; premium prices for bio-fortified/ nutritious crop varieties; grain/ food quality standards; agronomic practices to combat nutritional losses in food crops; balanced use of fertiliser nutrients; and promotion of nutrition sensitive value chains.
To fill the nutrient gap, there is a need to transition to nutrition sensitive agriculture (e.g. increased zinc, iron, vitamin-D, vitamin-B12 uptake) and functional/ fortified foods. This includes adoption of genetically modified (GM) crops like golden rice (to treat vitamin-A deficiency). Regenerative agriculture practices to include legumes in the cropping system would not only enhance food diversity but also improve soil health. Soybean is a legume known to be the most nutrient dense food. It is a kharif crop yet to be promoted in our rice-wheat dominated system.
The zinc and iron deficiency in the population is highly correlated with the deficiencies in the plant uptake from soils. Our foods are zinc and iron deficient for the same reason. Instead of giving zinc and iron pills to people, we should improve zinc and iron uptake by the crops.
The affordability and diversity challenges require investment in technology adoption to increase per unit productivity. Biotechnological and climate-smart strategies in agriculture/ food systems can mitigate food scarcity. Selective school meals or biscuits/ cookies will not serve the purpose. Transforimg crop and livestock production systems (genetics, agronomy and post-harvest management) can be a game changer. The holistic One Health approach can provide solutions by involving integrated community response for an actionable social protection pathway.
A pre- and post-Covid-19 pandemic comparison indicates an increase in food insecurity. The number of undernourished people has increased, and food prices have reached new highs (159.7 on FAO food price index). This has exacerbated the mother-child health crisis.
Essential nutrition services, including micro-nutrient supplementation, school feeding, breastfeeding and nutrition promotion are needed for nutrient-vulnerable communities. Some surveys have shown that the incidence of children coming to school without breakfast is related more to the lifestyle choice than lack of affordability. There is a significant disparity in school lunch practices based on socioeconomic status. Approximately 40 percent of students at schools for low-income families bring no lunch at all, while this percentage is considerably lower in schools for higher-income people. A high proportion of children from all income backgrounds rely on canteen-based lunch and sugary drinks. The practices can be cured by outreach and awareness programmes, especially for mothers.
The UNICEF, Scaling up Nutrition Academia and Research Network, and Scaling up Nutrition programmes in Pakistan are striving for mitigation of malnutrition with the provision of healthy/ safe food. The BISP, NGOs and government-driven programmes should focus on balanced food provision, diversification and eating habits to promote “my plate” concept. Social protection stewardship for nutrition and equitable provision of food and health services should be the priorities. Food pricing, affordability, food safety, incentivising agriculture and livestock farmers can change the analytical metrics of FNG.
University of Agriculture, Faisalabad, has several projects focused on FNG, including the US-Pak Centre for Advanced Studies in Agriculture and Food Security; Pak-Korea Nutrition Centre; Soybean Centre; and a pioneering degree programme on human nutrition and dietetics (HND) designed to promote availability of nutritious food. HND has been a huge success. Under Pak-Korea Nutrition Centre, the focus is on mother and child nutrition considering vulnerability of this group as identified in the WFP report. The centre is also focusing on indigenous foods and food compositions to promote locally derived solutions for food and nutritional diversity. Time is ripe to make nutrition education compulsory in the schools and nutrition teachers are appointed.
The writer is the former vice chancellor of the University of Agriculture, Faisalabad